Water-Based and Land-Based Exercise for Children with Post-COVID-19 Condition (postCOVIDkids)—Protocol 2022 Ogonowska-Slodownik et al

[Andy]

Abstract

The most common symptoms of post-COVID-19 condition in children are fatigue, shortness of breath, exercise intolerance, and weakness. The post-COVID-19 condition in children can be very debilitating and lead to prolonged school absences, high morbidity, and limitations in daily functioning. The aim of this research project is to determine the effectiveness of land-based and water-based exercise interventions on exercise capacity, fatigue, health-related quality of life, and pulmonary function in children with post-COVID-19 condition.

This study is a prospective randomized controlled study with pre- and post-intervention assessment. Participants will be recruited from Warsaw’s primary schools and primary healthcare units according to the inclusion criteria: (i) symptoms of post-COVID-19 condition lasting more than one month following initial COVID-19 infection confirmed by the diagnosis by general practitioner (including obligatory fatigue and shortness of breath/respiratory problems); (ii) age 10–12 years old. Participants meeting the inclusion criteria will be randomized to one of three groups: water-based exercise, land-based exercise, or control (no exercise). We hope this study will provide guidance for long-COVID-19 rehabilitation in children.

Open access, https://www.mdpi.com/1660-4601/19/21/14476/htm

 

[Arnie Pye]

From the Introduction :

Post-COVID-19 condition is defined as occurring at least four weeks after the onset of COVID-19, with symptoms that last for at least two months and cannot be explained by an alternative diagnosis.

I wonder how many of them were tested for anaemia and common nutrient deficiencies e.g. iron, ferritin, vitamin B12, folate, vitamin D etc?

 

[BrightCandle]

At least there is a control but it needs to be sham, its lacking blinded impacted. This really shouldn't pass ethical standards at all after what has happened with ME/CFS.

 

[rvallee]

Useless study as they've made it clear they intend for it to work by "trying" different modalities and clearly assume it should.

Oh, crap it's even worse than that:

Participants will be encouraged to exercise at an intensity of 6–8 (“getting quite hard” to “hard”) on the Pictorial Children’s Effort Rating Table (PCERT) [29]. Training intensity will be measured twice during the aerobic exercise training, during each circuit. If participants report an exercise intensity below 6 on the PCERT, they will be encouraged to increase the intensity by increasing their speed and/or range of motion.

The issue is not deconditioning. This is completely inappropriate as it's not the problem at all, there is simply no need to think this is any relevant at all.

After the first month of exercises, in order to make the classes more attractive and maintain exercise intensity, music and friendly competition between the participants will be introduced.

They view the problem as an issue of motivation. Clueless.

As missing cases are not expected to exceed 10% of the initial number of subjects, data will be analyzed as complete case analysis, excluding the missing data from the analysis

The number of missing cases for experiments like this is usually higher than 10%. And they oddly contradict this after:

However, we may face the major limitation of drop out of participants taking into account the length of the intervention (8 weeks) and frequency (2 times per week)

So is missing data not expected or expected? Anyway they plan not to record drop-outs so that takes care of that.

Therefore, in an effort to avoid a high attrition rate, we have planned a reward system during the interventions and a gift (fit band) for all children after the final assessment has been completed

They cannot see it any other way than as an issue of motivation. And this seems very wrong in a clinical trial, even a sham one.

In adults with post-COVID-19 condition, many of the recommendations for exercise training have been extrapolated from evidence for people with chronic respiratory disease due to the limited evidence in people with post-COVID-19 condition

Long Covid is not a chronic respiratory disease and has been known to be different for a long time already. But who cares about details, right? This is BPS research after all, details can be made-up as needed. Especially as this is mostly false, the evidence is a mix of confusion about COVID being only a respiratory disease and, of course, the evidence for "chronic fatigue". This is easy to find out.

And some bizarre stuff:

The strength of the study described here is the simple design and low-cost exercise training intervention, which, aside from access to a pool or gym, requires no expensive equipment, making it feasible to implement

This is not a strength, it's typical. They are fully generic exercise programs that never require equipment to avoid placing unnecessary barriers. And unneeded anyway.

Again more bizarre stuff:

Further, the intervention enables groups of patients to access therapy at the same time, which may have additional advantages for a child’s psychosocial wellbeing following many years of isolation due to lockdowns and periods of home schooling.

Children obviously did not spend many years in isolation. Isolation has a meaning, come on, at least pretend to be serious here.

But since outcomes are irrelevant, there is no reliable way to assess chronic illness and most will recover eventually, I have no doubt that they will see it as and claim success no matter what. Late-stage medicine is truly awful stuff. It's offensive, frankly.